<!DOCTYPE html>
<html>

<head>
    <title>兑换蟹券</title>
    <include file="public@head" />
</head>

<body class="check_gr">
    <div class="container-fluid">
        <div class="row title">
            <img src="{:cmf_get_image_preview_url($img)}" alt="">
        </div>
        <div class="row no">
            <div class="col-xs-12">
                <form class="form-horizontal" method="post" action="{:url('CardPub/redeempost')}">
                    <div class="form-group">
                        <label for="inputName" class="col-sm-2 control-label">名称</label>
                        <div class="col-sm-10">
                            <input type="text" class="form-control" id="inputName" name="name" placeholder="您的名称">
                        </div>
                    </div>
                    <div class="form-group">
                        <label for="inputTele" class="col-sm-2 control-label">电话</label>
                        <div class="col-sm-10">
                            <input type="text" class="form-control" id="inputTele" name="tele" placeholder="您的电话">
                        </div>
                    </div>
                    <div class="form-group">
                        <label for="inputAdd" class="col-sm-2 control-label">详细地址</label>
                        <div class="col-sm-10">
                            <textarea class="form-control" name="address" id="inputAdd" cols="30" rows="3" placeholder="您的详细地址"></textarea>
                        </div>
                    </div>
                    <div class="form-group div_btn">
                        <div class="col-sm-offset-2 col-sm-10">
                            <input type="hidden" name="openid" value="{$openid}">
                            <input type="hidden" name="pub_id" value="{$parameter[0]}">
                            <input type="hidden" name="no" value="{$parameter[1]}">
                            <input type="hidden" name="psd" value="{$parameter[2]}">
                            <button type="submit" class="btn btn-default">提交兑换</button>
                        </div>
                    </div>
                </form>
            </div>
        </div>
        <div class="row tips">
            <div class="col-xs-12">
                请如实填写您的信息，方便我们快递寄送。谢谢
            </div>
        </div>
    </div>
    <include file="public@scripts" />
</body>

</html>